In 2011, when the Colorado General Assembly created a state-run Obamacare bazaar, the intent was “to increase access, affordability, and choice for individuals and small employers purchasing health insurance.” The health-benefits exchange, Connect for Health Colorado (CFHC), went live in October 2013. And although a change this systemic needs years before it can be judged fairly, two years seems time enough to see if it’s trending in the right direction.

Data from the CFHC support a positive prognosis: The share of uninsured Coloradans fell from 17 percent in 2013 to 11 percent in 2014. A Colorado Health Institute (CHI) study says that number dropped even lower this year, but it had not released the figure by press time. Those who qualify for premium tax credits—households making between 138 percent and 400 percent of the federal poverty level, or between $33,465 and $97,000 a year for a family of four—are saving an average of $228.95 each month. Finally, most states average six carriers that offer individual plans, according to the Kaiser Family Foundation; Colorado boasts 10. But has hitting these targets translated into a healthier population? That diagnosis is still murky.

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First of all, even with the subsidy many poor Coloradans still can’t afford insurance. In the second quarter of 2015, 90 percent of clients at Metro Community Provider Network (MCPN)—a Denver nonprofit that serves roughly 43,000 patients annually, most of whom are uninsured or covered by Medicaid—who looked into CFHC coverage didn’t apply. Most couldn’t cover the premiums, says Claudia Frey-Grant, MCPN’s outreach program manager.

Those who do sign up aren’t springing for the deluxe package. Affordable Care Act plans fall under “metal” tiers, from platinum (the most expensive premiums) to bronze (least expensive). At 41 percent, the Centennial State has the highest share of bronze enrollees in the country. The problem is, the average bronze copay for a
primary care visit in Colorado is $48, while the deductible is $5,265, according to the Commonwealth Fund, which supports health-care research. That may explain why the CHI found that Coloradans with CFHC insurance were less likely (compared to those with non-CFHC insurance) to have visited their doctors in the past year—which affects not only their health but also the future of CFHC. “If a person purchases health insurance in the exchange and doesn’t particularly know how to use it or access care, they may not see the benefit [to their health] and not re-enroll,” says Adela Flores-Brennan, executive director of the Colorado Consumer Health Initiative and a CFHC board member.

Still, when open enrollment begins next month, we will have more health-insurance options than ever. Unfortunately most carriers are seeking a raise on premiums—from two to 34.4 percent—meaning for some Coloradans, the choice between the health of their bodies and the health of their bank accounts might only get more difficult.